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CMAJ
CMAJ - August 11, 1998 JAMC - le 11 août 1998 date

Surgery in stereo

CMAJ 1998;159:220

In response to: M.R. McKenzie; D. Kondziolka, M.D. Cusimano
What Drs. Kondziolka and Cusimano refer to as the "slow" development of radiosurgery in Canada really represents a cautious approach and a desire to rigorously define the indications for radiosurgery, so that no patient is subjected to unnecessary treatment.

For physics comparisons, I would call attention to a report of poor correspondence between calculated dose and measured radiation effect for the Gamma Knife1 (Fig. 3 in that article) and the good correspondence reported by our centre2 (Fig. 2 in that article).

I certainly agree that "Canadian physicians must recommend treatments on the basis of safety, efficacy and cost-effectiveness." With these criteria, they may very well choose treatment in Canada.

Michael Schwartz, MD, MSc
Head, Division of Neurosurgery
Sunnybrook Health Science Centre
Associate Professor
Department of Surgery
University of Toronto
Toronto, Ont.
m.schwartz@utoronto.ca

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References
  1. Flickinger JC, Lunsford LD, Wu A, Maitz AH, Kalend AM. Treatment planning for Gamma Knife radiosurgery with multiple isocenters. Int J Radiat Oncol Biol Phys 1990;18(1):1495-501.
  2. Ramani R, O'Brien PF, Davey P, Schwartz ML, Young CS, Lightstone AW, et al. Implementation of multiple isocentre treatment for dynamic radiosurgery. Br J Radiol 1995;68:731-5.